Sivak E D
Department of Pulmonary Disease, Cleveland Clinic Foundation, OH 44195.
Semin Thorac Cardiovasc Surg. 1991 Jan;3(1):53-62.
The foregoing discussion has reviewed the concept that postoperative ventilator dependency following heart surgery is due to a combination of risk factors, partly due to the nature of the patient population and partly to the process of patient care. Weaning from mechanical ventilation has been a controversial topic for decades, but the issue of rehabilitation before successful weaning has only recently achieved recognition. The fact that this process is often prolonged suggests that a certain logic must be used during the rehabilitation process. Appropriate minimization of risks with continued mechanical ventilation and concise protocols for gradually withdrawing support of mechanical ventilation may insure the quality of the patient care process. It should be understood by both the physician and patient that the ventilator for the patient population discussed previously acts merely as a "crutch" that will facilitate the process of rehabilitation.
上述讨论回顾了这样一个概念，即心脏手术后对呼吸机的依赖是多种风险因素共同作用的结果，部分归因于患者群体的特性，部分归因于患者护理过程。几十年来，从机械通气中撤机一直是一个有争议的话题，但成功撤机前的康复问题直到最近才得到认可。这个过程往往持续很长时间，这一事实表明在康复过程中必须运用一定的逻辑。通过持续机械通气适当降低风险，并采用逐步撤离机械通气支持的简洁方案，可能会确保患者护理过程的质量。医生和患者都应该明白，对于前面讨论的患者群体来说，呼吸机仅仅起到一个“拐杖”的作用，它将有助于康复过程。
